Glendale, AZ · Maricopa County
Business Ownership/Contact Supplemental Form
This supplemental form collects business ownership and contact details for a business associated with a Glendale license.
What this form is
The form records a business’s legal entity name, DBA, location, and current license number, if applicable. It also collects the names, titles, addresses, phone numbers, email addresses, and Social Security numbers of up to five owners, officers, members, or contacts. The owner, officer, partner, or statutory agent signs and dates the form.
Who needs it
A business owner, officer, partner, or statutory agent can use this form to provide business and owner or contact information to the Licensing Office.
How to submit it
The form lists the Licensing Office at 5850 West Glendale Avenue, Glendale, Arizona 85301-2599, and gives [email protected] as an email contact. It also lists 623-930-3190.
About notarization
This form has no notary block; the owner, officer, partner, or statutory agent just signs and dates it.
How to submit this form
- 1
Download The Form
Download the Business Ownership/Contact Supplemental Form PDF.
- 2
Complete Business Details
Enter the business legal entity name, DBA, location, and current license number if applicable.
- 3
Add Owner Or Contact Details
Provide the requested information for each owner, officer, member, or contact, up to five people.
- 4
Sign And Date
Have the owner, officer, partner, or statutory agent sign and date the form.
- 5
Send To The Licensing Office
Use the Licensing Office address or email listed on the form.
Frequently asked questions
- What information does the Business Ownership/Contact Supplemental Form ask for?
- It asks for business legal entity and DBA names, location, license number if current, and details for up to five owners, officers, members, or contacts.
- Who signs the Business Ownership/Contact Supplemental Form?
- The form provides a signature and date line for an owner, officer, partner, or statutory agent.
- Do I need a notary for the Business Ownership/Contact Supplemental Form?
- No. The form has no notary block; the owner, officer, partner, or statutory agent just signs and dates it.
- How do I submit the Business Ownership/Contact Supplemental Form?
- The form lists the Licensing Office address and the email [email protected]. Contact the office using the details printed on the form.
Need something notarized?
This Business Ownership/Contact Supplemental Form doesn’t need a notary — but if you have another Glendale form that does, a commissioned online notary can help.